Development and Validation of a Novel Prediction Model for Differential Diagnosis Between Crohn's Disease and Intestinal Tuberculosis. Issue 9 (September 2017)

• Record Type: Journal Article
• Authors: Bae, Jung Ho; Park, Sang Hyoung; Ye, Byong Duk; Kim, Seon-Ok; Cho, Yun Kyung; Youn, Eun Ja; Lee, Ho-Su; Hwang, Sung Wook; Yang, Dong-Hoon; Kim, Kyung-Jo; Byeon, Jeong-Sik; Myung, Seung-Jae; Yang, Suk-Kyun
• Is Part Of: Inflammatory bowel diseases. Volume 23:Issue 9(2017)
• Publication Date: 2017-09
• Subjects: Crohn's disease -- gastrointestinal tuberculosis -- prediction model; Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/MIB.0000000000001162
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Although colonoscopy is useful for differentiating between Crohn's disease (CD) and intestinal tuberculosis (ITB), the technique has limitations. We developed a practical prediction model for differentiating between CD and ITB using laboratory and radiologic parameters and colonoscopic characteristics. Methods: We prospectively enrolled 80 patients newly diagnosed with CD (n = 40) and ITB (n = 40). We developed a new prediction score by integrating colonoscopic, laboratory, and radiologic parameters. The score's predictive ability was validated on an additional 37 patients. Results: The accuracy of colonoscopic scoring for differentiation was 81.2% (65/80), with 65.0% sensitivity for CD and 97.5% for ITB. In multivariate analysis, positive IgA and/or IgG anti– Saccharomyces cerevisiae antibody and involvement of the proximal intestine were the independent laboratory and radiologic parameters for CD, and positive QuantiFERON-TB Gold In-Tube Test and typical pulmonary TB findings were the parameters for ITB. A new prediction scoring combining colonoscopic, laboratory, and radiologic factors increased the accuracy of diagnosis from 81.2% to 96.3% (77/80). The CD prediction score (from −2 to 2) estimated the likelihood of CD, from 0.3% for patients scoring −2 to 100% for patients scoring 2. The area under the receiver operating characteristic curve of the score was 0.990 in the development group and 0.981 in the validation group. Conclusions: The new prediction model using a CD prediction score can be useful for calculating the probability of either CD or ITB at initial evaluation (NCT01392365). Abstract : Article first published online 28 June 2017.Supplemental Digital Content is Available in the Text.